Provider Demographics
NPI:1255646790
Name:SHAW, SHEILA ANN (MSW-CC)
Entity type:Individual
Prefix:
First Name:SHEILA
Middle Name:ANN
Last Name:SHAW
Suffix:
Gender:F
Credentials:MSW-CC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 498
Mailing Address - Street 2:
Mailing Address - City:MARS HILL
Mailing Address - State:ME
Mailing Address - Zip Code:04758-0498
Mailing Address - Country:US
Mailing Address - Phone:207-425-3880
Mailing Address - Fax:207-426-9048
Practice Address - Street 1:14 MAIN ST.
Practice Address - Street 2:
Practice Address - City:MARS HILL
Practice Address - State:ME
Practice Address - Zip Code:04758-0498
Practice Address - Country:US
Practice Address - Phone:207-425-3880
Practice Address - Fax:207-426-9048
Is Sole Proprietor?:No
Enumeration Date:2010-08-09
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC12692104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker